Author + information
- Received July 9, 2010
- Accepted July 17, 2010
- Published online March 8, 2011.
A 65-year-old man with a 6-week history of recurrent syncope owing to torsade de pointes (A) was referred to our institute for cardioverter defibrillator implantation. An electrocardiogram on admission was normal, but the Holter monitoring performed in his local hospital showed paroxysmal ST-segment elevation and depression (B). He was then brought to the catheterization lab where coronary angiography was performed first. After several unsuccessful attempts to cannulate the left main ostium, the right coronary ostium was catheterized. The contrast injection showed a single right coronary artery (C, Online Videos 1 and 2) with a significant stenosis in the middle segment (D, Online Videos 1 and 2). The distal right coronary artery divided into a large posterior descending artery (PDA) and a large posterolateral ventricular (PLV) branch. In addition to running along the posterior atrioventricular groove and supplying the posterior part of the heart, the PDA extended beyond the apex, reversely coursed in the anterior interventricular groove and terminated near the left coronary sinus, supplying the left ventricular anterolateral wall. The PLV branch provided a number of big branches to supply the lateral wall. Coronary stenting was subsequently performed with a 3.5-mm sirolimus-eluting stent. The final angiographic result was excellent, without residual stenosis (E, Online Video 3). Multislice cardiac computed tomography was performed later and demonstrated the aberrant monocoronary anatomy and the widely patent stent (F and G). The patient was free of syncope at follow-up, and repeated Holter monitoring did not record any changes in the ST-segment or episodes of ventricular arrhythmia.
- Received July 9, 2010.
- Accepted July 17, 2010.
- American College of Cardiology Foundation